From lagging well behind most European countries in the early 1990s, the UK is now one of the highest spenders on the under-5s in Europe (OECD, 2014). One of the biggest programmes for this age group is Sure Start. It offers families with children under the age of 5 a "one-stop shop" for childcare and early education, health services, parenting support, and employment advice, with the aim of improving children's school readiness, health, and social and emotional development. Sure Start has had a turbulent history. The programme was first introduced in 1999 as Sure Start Local Programmes, targeted at highly disadvantaged neighbourhoods. Five years later, the 10-Year Strategy for Childcare called for "a children's centre in every community", transforming the initiative into a universal service. At its peak in 2009-10, Sure Start accounted for £1.8 billion of public spending (in 2018-19 prices), about a third of overall spending on programmes for the under-5s (Belfield, Farquharson and Sibieta, 2018). But in the decade since, the context has been one of funding cuts, consolidation and centre closures, with funding falling by two-thirds to £600 million in 2017-18. Despite its rapid expansion and the subsequent cuts, evidence on the impact Sure Start has had on the health of children and their families is still relatively scarce. The initial evaluation of the programme focused on the earliest years of Sure Start and found some health benefits for children living in neighbourhoods with access to the earliest Sure Start Local Programmes. A subsequent evaluation centred on describing and assessing different patterns of family use in the early 2010s and found little evidence of a link between more frequent use of services and children's health. In this report, we take a step back to consider the overall impacts on health of the Sure Start programme as a whole between its inception in 1999 and its peak in the late 2000s. Our focus on health outcomes is motivated by the fact that, while Sure Start's services were multifaceted and varied between centres and over time, one of its objectives was to improve children's health and an important component of its offer was health services. These include both direct provision of new services (e.g. baby-weighing clinics) and outreach to signpost parents to existing healthcare.
